DG Journal Club
AUTHORS: Marthe GlCersen, Pernille Steen Pettersen et al.
OBJECTIVE To examine the association of body mass index (BMI) with pain in people with hand osteoarthritis, and explore whether this association, if causal, is mediated by systemic inflammatory biomarkers.
METHODS In 281 Nor-Hand study participants, we estimated associations between BMI and hand pain by Australian/Canadian Osteoarthritis Hand Index (AUSCAN, range 0-20) and Numerical Rating Scale (NRS, range 0-10), foot pain by NRS (range 0-10), knee/hip pain by Western Ontario/McMaster Universities Osteoarthritis Index (WOMAC, range 0-20), painful total body joint count and pain sensitization. We fit natural-effects models to estimate natural direct and indirect effects of BMI on pain through inflammatory biomarkers.
RESULTS BMI change, quantified per 5-unit increase, was associated with more severe hand pain (on average increased AUSCAN by 0.64, 95% CI: 0.23-1.08), foot pain (on average increased NRS by 0.65, 95% CI: 0.36-0.92), knee/hip pain (on average increased WOMAC by 1.31, 95% CI: 0.87-1.73), generalized pain and sensitization. Mediation analyses suggested that BMI effect on hand pain and painful total body joint count were partially mediated by leptin and high-sensitivity C-reactive protein (hs-CRP), respectively. Effect sizes for mediation by leptin were larger in hands than in lower extremities, and statistically significant in hands only.
CONCLUSION In people with hand osteoarthritis, higher BMI was associated with greater pain severity in hands, feet and knees/hips. Systemic effects of obesity, measured by leptin, may play a larger mediating role for pain in hands than in lower extremities. Low-grade inflammation, measured by hs-CRP, may contribute to generalized pain in overweight/obese individuals.
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